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Home My WebLink About174348 07/08/2009 CITY OF CARMEL, INDIANA VENDOR: 363045 Page 1 of 1 ONE CIVIC SQUARE MONIKA HERZIG CARMEL, INDIANA 46032 3375 E OLD MYERS ROAD CHECK AMOUNT: $500.00 BLOOMINGTON IN 47408 CHECK NUMBER: 174348 CHECK DATE: 7/8/2009 DEPARTMENT ACCOUNT PO NU MBER IN VOICE N UMBER AMOUNT DESCRIPTION 902 4359003 500.00 FESTIVAL /COMMUNITY EV F .q Monika Herzig 3375 E Old Myers Rd Bloomington, IN 47408 USA 812 -334 -3022/ 812- 369 -8217 mh.erziggindiana. edu www.monikaherzig.com To Carmel Redevelopment Commission 30 W. Main St. suite 220 Carmel, IN 46032 fax (317) 571 -2789 INVOICE For concert with the Monika Herzig Acoustic Project, Sunday, July 19, 1 -4pm Total: $500 Payable to: Monika Herzig 3375 E Old Myers Rd A Bloomington, IN 47408 SS# 416 -31 -5908 Form W 9 Request for Taxpayer Give form to the (Rev- Oclober 2004) Identification Number and Certification requester. Do not Department of the Treasury send to the IRS. Internal Revenue Service C i Name (as reported on your inc me lax return) m tz Business name, if different from above c O tl o Indivld uaV Exempt from backup Check appropriate box: Sete proprietor ❑Corporation f 1 Partnership S Other w ithholdin g 0 y Address number, street, and apt, or suite nc Requester's name antl address (optional) IL O City, St a and ZIP code d 7 o Q. f List account number here onal a num 4 a. Taxpayer Identification Number (TIN) Enter your TIN in the appropriate box. The TIN provided must match the name given on Line 1 to avoid I social security number backup withholding. For individuals, this is your sociat security number (SSN). However, for a resident �I l tJ 45 1 J q 10 Ig alien, sole proprietor, or disregarded entity, see the Part I instructions on page 3. For other entities, it is your employer identification number (EIN). If you do not have a number, see How to get a TIN on page 3. or Note. If the account is in more than one name, see the charl on page 4 for guidelines on whose number Employer identification number to enter. Certification Under penalties of perjury. I certify that: 1 The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me), and 2. 1 am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I am no longer subject to backup withholding, and 3. 1 am a U.S. person (including a U.S. resident alien). Certification instructions. You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because you have failed to report all interest and dividends on your tax return. For real estate transactions, item 2 does not apply. For mortgage interest paid, acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement (IRA), and generally, payments other than interest and dividends, you are not required to sign the Certification, but you must provide your correct TIN. (See the instructions on page 4.) Hire Signature of 0 Here U.S. person IN- Date _l Purpose of f=orm A person who is required to file an information return with the any estate (other than a foreign estate) or trust. See IRS, must obtain your correct taxpayer identification number Regulation section 301.7701 -6(a) for additional information. FIN) to report, for example, income paid to you, real estate Foreign person. If you are a foreign person, use the transactions, mortgage interest you paid, acquisition or appropriate Form W -B (see Publication 515, Withholding of abandonment of secured property, cancellation of debt, pr Tax on Nonresident Aliens and Foreign Entities), contributions you made to an IRA. Nonresident alien who becomes a resident alien. U.S, person. Use Form W -9 only if you are a U.S. person Generally, only a nonresident alien individual may use the (including a resident alien), to provide your correct TIN to the terms of a tax treaty to reduce or eliminate U.S. tax on person requesting it (the requester) and, when applicable, to: certain types of income. However, most tax treaties contain a 1. Certify that the TIN you are giving is correct (or you are provision known as a "saving clause." Exceptions specified waiting for a number to be issued), in the saving clause may permit an exemption from tax to 2. Certify that you are not subject to backup withholding, continue for certain types of income even after the recipient or has otherwise become a U.S. resldent alien for tax purposes. 3. Claim exemption from backup withholding if you are a If you are a U.S. resident alien who is relying on an U.S. exempt payee. exception contained in the saving clause of a tax treaty to Note. It a requester gives you a form other than Form W -9 to claim an exemption from U.S. tax on certain types of income, request your TIN, you must use the requester's form if it is you must attach a statement that specifies the following five substantially similar to this Form W -9. items: For federal tax purposes you are considered a person if you 1, The treaty country. Generally, this must be the same are: treaty under which you claimed exemption from tax as a an individual who is a citizen or resident of the United nonresident alien. States, 2. The treaty article addressing the income. 0 a partnership, corporation, company, or association 3. The article number (or location) in the tax treaty that created or organized in the United States or under the laws contains the saving clause and its exceptions, of the United States, or Cat. No- 10231X Form W -9 (Rev. 10 -2004) Prescribes by State Board of Accounts City Form No. 201 (Rev. 1995) ACCOUNTS PAYABLE VOUCHER CITY OF CARMEL An invoice or bill to be properly itemized must show: kind of service, where performed, dates service rendered, by whom, rates per day, number of hours, rate per hour, number of units, price per unit, etc. �j Payee /U��« /7 pis Purchase Order No. 3 7 CIolF "Z r� �a y� Terms 7t,, 1 Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) Total SGY,.Q�j I hereby certify that the attached invoice(s), or bill(s), is (are) true and correct and I have audited same in accordance with IC 5- 11- 10 1.6. 20 Clerk- Treasurer VOUCHER NO. WARRANT NO. ALLOWED 20 IN SUM OF r ON ACCOUNT OF APPROPRIATION FOR 9o y .5�9'�0�3 Board Members E or INVOICE NO. ACCT #/TITLE AMOUNT fl�PT. I hereby certify that the attached invoice(s), or 90 2 50 0,V bill(s) is (are) true and correct and that the materials or services itemized thereon for which charge is made were ordered and received except %5 20 0, Signature Director of Operations Title Cost distribution ledger classification if clairn paid motor vehicle highway fund d,